Cobalamin Deficiency in Elderly Patients: A Personal View

Table 3

Food-cobalamin malabsorption syndrome [4, 14, 15].

Criteria for food-cobalamin malabsorption	Associated conditions or agents
– Low-serum cobalamin (vitamin B12) levels	– Gastric disease: atrophic gastritis, type A atrophic gastritis, gastric disease associated with Helicobacter pylori infection, partial gastrectomy, gastric by-pass, and vagotomy
– Normal results of Schilling test using free cyanocobalamin labeled with cobalt-58, or abnormal results of derived Schilling test^‡	– Pancreatic insufficiency: alcohol abuse
– No anti-intrinsic factor antibodies	– Gastric or intestinal bacterial overgrowth: achlorhydria, tropical sprue, Ogylvie’s syndrome, and HIV
– No dietary cobalamin deficiency	– Drugs: antacids (H2-receptor antagonists and proton-pump inhibitors) or biguanides (metformin)
	– Alcohol abuse
	– Sjögren’s syndrome, systemic sclerosis
	– Haptocorrine deficiency
	– Ageing or idiopathic

^‡Derived Schilling tests use food-bound cobalamin (e.g., egg yolk, chicken, and fish proteins).